Intrauterine Insemination

Intrauterine Insemination (IUI), one of the methods of artificial insemination, is a simple and safe treatment modality in infertility aimed at overcoming the natural barriers to the passage of the sperms from the vagina to the fallopian tubes. During IUI, a prepared semen sample with adequate numbers of motile, normal sperms suspended in a nutrient medium are directly placed in the uterine cavity, thus by passing the need for sperms to travel from the vagina to the uterus. This is done around the predicted time of ovulation. With IUI the number of sperms that reach the fallopian tube is increased by as much as 25%.

Indications

• Sexual problems in the male impotence: premature ejaculation.
• The cervix is hostile and thereby destroys the sperms, as evidenced by certain tests.
• Impaired semen quality low or absent counts, low motility etc.
• Unilateral tubal block
• Unexplained infertility all tests for infertility in the male and female are normal, yet the woman is unable to conceive.

Initial work-up

Through a comprehensive history, examination and laboratory investigations the following facts are confirmed.

• The ovary contains healthy oocytes or eggs, the fallopian tubes are patent or open and the uterus in normal.
• The semen sample contains a sufficient number of motile normal sperms.
• The husband or donor has no infectious diseases or genetic abnormality.

Ovulation Induction

IUI may be performed at the time of ovulation in a natural menstrual cycle or in a cycle where the ovaries have been stimulated by certain drugs. Ovulation induction or stimulation of the ovaries, is the administration of certain drugs which act on the ovaries and stimulate them to produce more eggs, thus improving the chances of conception. The woman is asked to attend the clinic on the 2nd day of her menstrual cycle. After an ultrasound examination to check her uterus she is prescribed medication to stimulate her ovaries. Such drugs are administered to ensure that the ovaries produce more than one egg to improve chances of conception.

Timing of ovulation

To predict the time of ovulation, the woman will have to undergo ultrasound examinations on alternate days from the 8th or 10th day of her cycle. At the predicted time of ovulation insemination is carried out with the prepared semen sample. Sperms have the ability to fertilize for up to 48 hours and a mature egg is capable of being fertilized for approximately 12-18 hours after ovulation.

Preparation of the semen sample

Abstinence is to be observed 3-4 days prior to the procedure. On the day of the insemination the husband gives a semen sample in a wide-mouthed sterile container provided by the Clinic. The sample should be obtained by masturbation and not coitus interuptus. Facilities ensuring privacy are available at the Clinic for this purpose. After the specimen has been given for processing, the couple can leave and return for the insemination 1-2 hours later.
The semen sample is assessed for volume, count and motility. The semen is then washed, which in essence refines and concentrates the sperms enhances the fertilizing capacity of the seen specimen. Only motile normal sperms are obtained thereby eliminating all other contents. The sperms are suspended in a nutrient medium and this sample is used for insemination.

Frozen semen of the husband may also be used for insemination. This is done when the husband cannot be present at the time of insemination. However a fresh sample is preferred.

The Insemination Procedure

• IUI is a relatively simple and straight forward technique performed transvaginally as an outpatient procedure.
• There is no need for the woman to fast or rest before the insemination procedure.
• The woman is asked to pass urine so that her bladder is empty.
• The woman lies on a couch or bed with her hips raised on a pillow.
• The mouth of the uterus called the cervix is visualized by means of an instrument inserted into the vagina. The cervix is cleansed of mucus. The anterior lip of the cervix is held with a forceps. All these do not cause pain to the woman.
• The IUI catheter with the processed semen sample is gently introduced into the uterus.
• The processed semen is injected slowly into the uterus over 30-60 seconds.
• The woman is asked to continue lying down for the next 30 minutes.
• She is then allowed to leave and can resume her routine activities immediately on return.

Insemination is usually performed on two consecutive days in any one cycle.
At our centre couples are generally advised to attempt two or three cycles of insemination. If they fail to conceive their records are reviewed for re-evaluation of treatment.

After-care

• After IUI the woman will be asked to take some medications which help make the uterine lining or endometrium receptive to implantation of an embryo.
• There is no restriction in activity. There is no need for bed rest, diet and travel restrictions.

Side effects

• Side effects are extremely rare and may include uterine cramps in about 5% of patients, spotting in about 1% and gastrointestinal upsets or nausea in about 0.05% of patients.
• Sterile conditions ensure that infection very rarely occurs. Antibiotics are not necessary for the woman or her partner either before or after the procedure.

This is some background information about the procedure. If you have any further queries please approach the front desk to schedule an appointment with one of our doctors. We would be happy to be of assistance.